Forward Motion

Greene is a track athlete at a metro Richmond high school. Quiet, but observant, and wise beyond his years.

He had top surgery the summer of his sophomore year. It’s a gender-affirming procedure, confirmation of a truth that’s long seemed obvious to Greene.*

He’s a boy, and that’s that.

“You’ve got to live your life authentically,” he says.

He’s not open to everyone about his transitioning; he doesn’t feel the need to be. None of his teammates know. They don’t need to; just some of his friends; they’ve been especially supportive.

“It’s not something that’s important to me, personally,” he says.

He knew his gender “early on,” and began hormone treatments in eighth grade. His mom was concerned about the hormones, but Greene was adamant: Transitioning wasn’t something that he thought could wait.

Most of his extended family members have been supportive, including his grandmothers, though one was concerned at first by how his friends would react. One uncle, a political and religious conservative, has not. “That connection has ceased,” Greene says.

His mother and father have been supportive. “It wasn’t that much of a shock to my parents,” he says.

His parents had always known, and they have been there for him. He wanted to dress as a boy, so they shopped in the boy’s department, for example.

“I just let him have the room to be who he was,” says his mom.

She’s been very protective of him, advocating for her son at his schools, ensuring that he got the resources he needed and that he had time with the right professionals. She also saw to changing his name and birth certificate, his Social Security information and all the other details of confirming identity.

Greene says he was subjected to name-calling in middle school, but he’s been able to put it into perspective.

It made me a lot angrier then,” he says.

He hasn’t felt endangered, though others have. Ten percent of transgender people in a 2015 survey reported they had been subjected to violence from a family member, and 8 percent reported they had been kicked out of their home. About 54 percent of the trans students participating in the National Center for Transgender Equality survey said they had been verbally harassed at school. Also, 24 percent had been attacked physically, and 13 percent reported they had been sexually assaulted.

And yet, there’s also growing acceptance evident in the survey: About 56 percent of students say they felt accepted by their peers, and 68 percent of adult survey participants said they felt accepted by co-workers.

Kids who are trans and nonbinary often have poor mental health, with higher rates of depression, suicide and anxiety, according to Susan Jones, a Children’s Hospital of Richmond at VCU specialist in child and adolescent psychiatry.

Regarding gender identity, parents may be more confused than their kids. Jones says that parents bring their children in to specialists because they’re unsure what’s going on. What the doctors look for is called persistent gender dysphoria at puberty, a sense of discomfort and stress.

For elementary-age children, when parents are looking for guidance and want nothing permanent or damaging, no medications are prescribed. Jones says that with younger children, parents and family members are encouraged to be accepting and gender-affirming, taking such steps as letting the child dress at home in their preferred gender, or while on vacation.

That approach may continue into middle school and high school, but at puberty, the child may be placed on medications or hormones to slow the process down, reversible medications that let them see the physical change, but also allowing them to put on the brakes and “figure it out.”

Once everyone is sure full transition is proper, surgery may follow. Few doctors do a transition at age 16; most bottom surgery is done at age 18.

Acceptance, and Costs

Greene brings a maturity to his outlook that belies his years. His advice, to kids and adults, is that when they think someone is trans, they shouldn’t be overbearing and shouldn’t pry. (See our piece on gender etiquette and terms.)

“It’s a very private matter,” he says. “You were just born with the wrong brain for the body.”

His top procedure was not covered by insurance — many medical insurances consider it a cosmetic procedure. His mother says that it was ruled to be not medically necessary, but she knows better, though it took time for her to get there. “I wrestled with it,” she says.

“It’s a very private matter. You were just born with the wrong brain for the body.”

A psychologist pushed the family beyond its comfort zone — to a greater understanding of what Greene was going through and how it was affecting him that he was in the wrong body.

“She was pretty awesome, getting us all through the process,” says Greene’s mom.

“People tend to second-guess you when doing that kind of surgery, but it was absolutely the right thing for my child.”

Greene knows he’s lucky that his family could cover the costs. Many people are not.

Jones notes society is more accepting, and that people generally are more accepting of gays and trans individuals. That’s also reflected in the current generation of parents she’s seeing, too, and that’s critical. “Family acceptance is really important,” Jones says.

Even with acceptance, younger trans people face many hurdles. The most pressing for many is the lack of services and the costs involved.

“Trans health services should be more accessible because it can make all the difference for achieving a certain comfort level for many transgender teens and young adults,” says Shannon McKay, a Richmond mother of a transgender student who was a founder in 2012 of a support group for transgender kids and young adults and their families, He, She, We and Ze.

Top surgery is more common and less costly. Bottom surgery is more involved and more expensive. Many transgender people rule out bottom surgery because of the cost or for personal reasons.

McKay notes that gender markers — the boxes that are checked on whether you are male or female on official documents including a driver’s license, and on school forms including report cards or team rosters — won’t be changed unless a youth has undergone hormone treatment or a procedure such as top surgery.

“That means that our young transgender students are having to go through a majority of their school experience with the wrong gender marker,” she says. “This causes a lot of stress and anxiety for our trans students.”

McKay says there must be tangible evidence of progress when it comes to perceptions of community acceptance of younger trans people. She wants school districts to incorporate gender identity and gender expression into nondiscrimination policies.

“All students should be able to choose to use the bathroom and locker room that matches their gender identity,” she says. “All students should have options to use a private bathroom if they choose, not just the trans kids being required to do so. “